Table II.

Nutritional assessment parameters

Clinical observation	•• Ability to chew and swallow •• Clinical signs of weight loss e.g. ill-fitting dentures/clothing •• Medical history which may affect nutritional intake e.g. coeliac disease, diabetes
Dietary history	Review of recent intake (24 hours recall), with attention being paid to: •• Fluid intake •• Changes in texture •• Reports of fullness •• Length of time and effort taken to eat •• Changes in appetite •• Gastrointestinal function
Calculation of requirements	Energy: •• 25–35 kcal/kg/day dependant on activity level. Can increase further if major complications. Protein: •• 0.8–2.0 g/kg/day for depleted of treatment complications Fluid: •• 30–35 ml/kg/day increases in infection and excessive fluid losses Vitamins and minerals: •• As per recommended daily amounts unless considered deficient
Proposed treatment	•• Disease status, tumour site •• Nutritional implications of previous and current treatment plan
Anthropometry	•• Height •• Weight •• Weight history •• Percentage weight change •• Body mass index; <18.5 kg/m2 suggests undernutrition •• Triceps skinfold thickness indicates fat stores •• Mid arm muscle circumference indicates lean tissue mass •• Hand grip strength assesses muscle function
Biochemistry	•• Urea and electrolytes – indicate fluid status although can be disrupted by disease state and treatment •• Albumin – not good indicator of nutritional status due to its long half-life (17–20 days) and it is affected by stress and sepsis •• Pre-albumin – shorter half-life 2–3 days but also affected by infection and stress •• C-reactive protein – indication of acute phase response •• Transferrin – affected by inflammation and infection •• Total lymphocyte count – affected by infection •• Refeeding syndrome risk
Social information	•• Alcohol intake •• Smoking •• Substance misuse •• Social support •• Dentition •• Access to food and cooking skills •• Social and financial circumstances •• Time taken to eat and drink •• Patient perception of nutritional status